Provider Demographics
NPI:1679867584
Name:RIVERA-GONZALEZ, BERENICE O
Entity Type:Individual
Prefix:
First Name:BERENICE
Middle Name:O
Last Name:RIVERA-GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WALGREENS #12659
Mailing Address - Street 2:PARQUE ESCORIAL 65 INF KM 54
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:787-768-5004
Mailing Address - Fax:787-757-3608
Practice Address - Street 1:PARQUE ESCORIAL 65 INF KM 54
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-768-5004
Practice Address - Fax:787-757-3608
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist